Organization
BLUE SAGE RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BOULAY MSAC (OWNER/CEO/COO)
(480) 356-4370
Entity
Organization
Contact information
Practice address
155 E RAY RD STE 2, CHANDLER, AZ 85225-3303
(480) 356-4370
Mailing address
11527 E STARKEY AVE, MESA, AZ 85212-7118
(480) 356-4370
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251B00000X
Case Management Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
06/28/2021
Last updated
06/28/2021
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